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Both FPG and 2-h PG Predict Mortality in Persons Not Known to Have Diabetes
DECODE Study
Key Points
Both fasting plasma glucose (FPG) and 2-hour PG above the normal range predict increased mortality
PG (measured by a 2-hour oral glucose tolerance test) is an independent predictor of mortality even among subjects with normal FPG; FPG alone does not fully predict mortality related to hyperglycemia
PG provides vital prognostic information and helps identify individuals at the greatest risk for mortality associated with early diabetes
The DECODE (Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe) study was conducted in persons not known to have diabetes to assess the prognostic impact of the revised diabetes diagnostic criteria proposed by the American Diabetes Association (ADA): namely, that a fasting plasma glucose (FPG) of >126 mg/dL be the diagnostic cut point for diabetes and that postchallenge glucose (PG) not be used on a routine basis for diagnosis.1
These findings demonstrated that FPG alone was not sufficient to predict mortality. As illustrated in the graph on the left, the risk of death by any cause increased in all categories of FPG above the normal range, regardless of a patient’s PG status (measured by an oral glucose tolerance test). However, as shown in the graph on the right, PG was an independent predictor of all-cause mortality, even among subjects with normal FPG (defined in this study as <110 mg/dL). This mortality risk increased with increasing 2-hour glucose concentrations, with the risk doubling at 2-hour PG >200 mg/dL.1
Not shown in this graph are the hazard ratios for subjects with normal PG and elevated FPG. These data led to hazard ratios ranging from 1.2 to 1.6, lower ratios than any outcomes that measured abnormal PG as well.1
These results verified that PG provides vital prognostic information, enables the identification of individuals with IGT before their fasting glucose levels become impaired, and may help identify individuals at the greatest risk for mortality associated with early diabetes.1
References
1. DECODE study group on behalf of the European Diabetes Epidemiology Group. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. Lancet. 1999;354:617-621.
